|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|4.2 Drugs used in psychoses and related disorders
Related guidance: NICE CG 178 (Updated March 2014) Psychosis and schizophrenia in adults: treatment and management
NICE Technology Appraisal TA213 (2011): Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years
|Antipsychotics||Antipsychotics are usually initiated within secondary care, following Somerset Partnership guidelines.
Prescribing responsibility may then be transferred to primary care in accordance with a Shared Care Agreement.
|All antipsychotics (except risperidone for short-term, <6 weeks, use – see below) are unlicensed for use in dementia and should only be used when a person is a risk to themselves and others and all other methods have been tried. Prescribers are reminded that all antipsychotics are associated with an increased risk of serious adverse reactions in elderly patients with dementia, (mortality, stroke, TIA and possibly cognition).|
|The choice of antipsychotic medication should be made by the service user and healthcare professional together, taking into account the views of the carer if the service user agrees. Provide information and discuss the likely benefits and possible side effects of each drug, including:
• metabolic (including weight gain and diabetes)
• extrapyramidal (including akathisia, dyskinesia and dystonia)
• cardiovascular (including prolonging the QT interval)
• hormonal (including increasing plasma prolactin)
• other (including unpleasant subjective experiences).
|Regular combined treatment with two or more antipsychotic agents is not recommended||Risperidone||1mg tablets: £4.23 (20)|
2mg tablets: £21.13 (60)
3mg tablets: £29.89 (60)
4mg tablets: £27.78 (60)
|Risperidone is licensed for the short-term treatment, , of persistent aggression in patients with moderate to severe Alzheimer’s dementia unresponsive to non pharmacological approaches and when there is a risk of harm to self or others.
NB Six-week restriction does not apply where risperidone is being prescribed to treat acute or chronic psychoses or mania
|Risperidone long acting injection|
NB Cold chain must be maintained.
|25mg: £79.69 (1 pfs)|
37.5mg: £111.32 (1 pfs)
50mg: £142.76 (1 pfs)
|Two-weekly injection as part of a shared-care arrangement.|
long acting injection ▼
|50mg: £183.92 (1 pfs)|
75mg: £244.90 (1 pfs)
100mg: £314.07(1 pfs)
150mg: £392.59 (1 pfs)
|Maintenance in schizophrenia in patients previously responsive to paliperidone or risperidone in accordance with the shared care guidelines. Suitable for patients who require antipsychotic medication and can be given as a long acting injection for those patients that have not tolerated other typical depot medications because of EPSE.
Paliperidone is an active metabolite of risperidone.
|Olanzapine||2.5mg tablets: £1.39|
5mg tablets: £1.47
7.5mg tablets: £2.34
10mg tablets: £1.67
15mg tablets: £1.76
20mg tablets: £2.49
|Aripiprazole||5mg tablets: £1.88|
10mg tablets: £1.65
15mg tablets: £1.81
30mg tablets: £41.51
|Aripiprazole is recommended as an option for the treatment of schizophrenia in people aged 15 to 17 years who are intolerant of risperidone, or where risperidone is contraindicated, or whose schizophrenia has not been adequately controlled with risperidone (NICE TA213).
Generic aripiprazole is not licensed for bipolar disease. Use branded Abilify®.
|Quetiapine||25mg tablets: £2.65 (60)|
100mg tablets: £6.10 (60)
150mg tablets: £7.31 (60)
200mg tablets: £9.13 (60)
300mg tablets: £7.08 (60)
|Where quetiapine is prescribed, the standard release formulation is preferred for long term use on cost grounds (approx. 15 x price difference). This approach is supported by Somerset Partnership NHS Foundation Trust Mental Health Directorate.|
as Sondate XL®
or Zaluron XL®
or Biquelle XL®
|50mg tablets: £11.99 (60)|
150mg tablets: £25.99 (60)
200mg tablets: £25.99 (60)
300mg tablets: £44.99 (60)
400mg tablets: £59.99 (60)
50mg tablets: £27.98 (60)
150mg tablets: £46.98 (60)
200mg tablets: £46.98 (60)
300mg tablets: £70.73 (60)
400mg tablets: £94.00 (60)
50mg tablets: £29.45 (60)
150mg tablets: £49.45 (60)
200mg tablets: £49.45 (60)
300mg tablets: £74.45 (60)
400mg tablets: £98.95 (60)
|For patients unable to take immediate release quetiapine, a once daily dose XL preparation is available. Generically prescribed XL preparations are 50% or more expensive than brands stated.|
|General advice||Offer people with psychosis or schizophrenia who smoke help to stop smoking, even if previous attempts have been unsuccessful. Be aware of the potential significant impact of reducing cigarette smoking on the metabolism of other drugs, particularly clozapine and olanzapine. [new 2014]
SmokefreeLife Somerset. The FREE stop smoking service serving and supporting Somerset residents to live up to their resolutions and pledge for a healthy and smokefree living.
|Levomepromazine is included in the Wessex Palliative Care guideline which Somerset CCG supports. For more information click here|